Over the last 50 years, medical student debt has become a problem of national importance, and obtaining medical education in the United States has become a loan-dependent, individual investment. Although this phenomenon must be understood in the general context of U.S. higher education as well as economic and social trends in late-20th-century America, the historical problem of medical student debt requires specific attention for several reasons. First, current mechanisms for students' educational financing may not withstand debt levels above a certain ceiling which is rapidly approaching. Second, there are no standards for costs of medical school attendance, and these can vary dramatically between different schools even within a single city. Third, there is no consensus on the true cost of educating a medical student, which limits accountability to students and society for these costs. Fourth, policy efforts to improve physician workforce diversity and mitigate shortages in the primary care workforce are inhibited by rising levels of medical student indebtedness. Fortunately, the current effort to expand the U.S. physician workforce presents a unique opportunity to confront the unsustainable growth of medical student debt and explore new approaches to the financing of medical students' education.
Dr. Greysen is Robert Wood Johnson Clinical Scholar, Yale University School of Medicine and West Haven VA Medical Center, New Haven, Connecticut.
Dr. Chen is assistant professor of pediatrics and health policy, George Washington University School of Medicine and Health Sciences, Washington, DC.
Dr. Mullan is Murdock Head Professor of Medicine and Health Policy, George Washington University School of Public Health and Health Services, Washington, DC.
Correspondence should be addressed to Dr. Greysen, Robert Wood Johnson Clinical Scholar, Yale University School of Medicine, 333 Cedar Street, SHM IE-61, New Haven, CT 06510; e-mail: firstname.lastname@example.org.